Tajikistan : Review of Public Expenditures on Health
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Washington, DC
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This policy note is part of the World
Bank's Programmatic Public Expenditure Review (PER)
work program for FY2012-2014. The PER consists of a series
of fiscal policy notes, which aim at providing the
Government of Tajikistan with recommendations to strengthen
budgetary processes and analysis. This policy note, the
second in the series, examines public expenditures on health
in Tajikistan. After an introductory section, the note
describes the institutional and administrative structure of
the health sector. Section 3 presents health outcomes and
health care utilization indicators. Section 4 describes
health financing in Tajikistan and presents the main options
to expand fiscal space for health. Section 5 reviews the
health financing and organizational reforms implemented in
Tajikistan. Section 6 provides the main conclusions: 1)
despite progress, health sector outcomes are mixed in
Tajikistan and utilization pattern of health services is
characterized by significant inequalities; 2) public
spending on health is relatively low and skewed towards
hospitals rather than outpatient care; 3) the hospital
sector is characterized by oversupply of beds, avoidable
inpatient admissions, low occupancy rates, and excessive
average length of stay; 4) an increase in public health
expenditures since 2000 was largely driven by the expanding
wage bill, while other expenditures had been compressed; 5)
public health expenditures show a regressive incidence, with
the distribution of inpatient care more pro-rich than
outpatient care; 6) the large reliance on out-of-pocket
produces a high incidence of catastrophic spending; 7) a
number of health financing and organizational reforms have
been initiated since 2000, but the scope and coverage is
still limited; and 8) the overall prospect for increasing
fiscal space for health in Tajikistan are positive, with
rationalization of both the overall budget and the public
health delivery system.
Palabras clave
FISCAL SPACE, HEALTHCARE USE, HEALTH FINANCING, HEALTH OUTCOMES, HEALTH SECTOR, HEALTH SERVICE INEQUALITY, ORGANIZATIONAL REFORMS, PUBLIC HEALTH EXPENDITURES